Skull‐base surgery during the COVID‐19 pandemic: the Italian Skull Base Society recommendations

Abstract

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which causes coronavirus disease 2019 , is highly contagious with devastating impacts for healthcare systems worldwide.Medical staff are at high risk of viral contamination and it is imperative to know what personal protective equipment is appropriate for each situation. Furthermore, elective clinics and operations have been reduced in order to mobilize manpower to the acute specialties combatting the outbreak; appropriate differentiation between patients who require immediate care and those who can receive telephone consultation or whose treatment might viably be postponed is therefore crucial.Italy was one of the earliest and hardest-hit European countries and therefore the Italian Skull Base Society board has promulgated specific recommendations based on consensus best practices and the literature, where available. Only urgent surgical operations are recommended and all patients should be tested at least twice (on days 4 and 2 prior to surgery). For positive patients, procedures should be postponed until after swab test negativization. If the procedure is vital to the survival of the patient, FFP3 and/or PAPRs devices, goggles, full-face visor, double gloves, water-resistant gowns and protective caps, are mandatory. For negative patients, use of at least FFP2 mask is recommended. In all cases the use of drills, which promote the aerosolization of potentially infected mucous particles, should be avoided. Given the potential neurotropism of SARS-CoV-2, dura handling should be minimized. It is only through widely-agreed protocols and teamwork that we will be able to deal with the evolving and complex implications of this new pandemic.

A snapshot of European neurosurgery December 2019 vs. March 2020: just before and during the Covid-19 pandemic

“…Three centers reported similar indications and retained ability to provide care as needed but decreased activity in March (19-28 + 2-5 beds). Four centers reported same indications and activity but an inability to meet all needs (31(10-84) + 9.5 [1-4, 6, 8, 11-22] beds); four centers reported similar indications but decreased activity and inability to meet all needs (33 (19-56) + 7 [1,2,6,8,[11][12][13][14] beds); and thirteen centers had limited their indications to treat patients.…”

“…We postulated that the supply of neurosurgical care would be in balance with demand and expectations in December 2019, but that supply would decrease and affect neurosurgical care during the pandemic. Several guidelines and recommendations have been recently published on how to manage the pandemic and possible shortage of resources [4,11,15,22]. The guidance comprises prioritization by postponing non-urgent cases, triaging of cases to use resources effectively and optimally meet individual medical needs, and, finally, rationing of cases: the process of selection of who will not be treated to optimally meet a medical need.…”

Optimum Naso‐oropharyngeal Swab Procedure for COVID‐19: Step‐by‐Step Preparation and Technical Hints

“…To further improve the sensitivity, the execution of two nasopharyngeal swabs, separated by at least 2 to 4 days, is recommended. 4 Another important issue related to the swabbing procedure concerns patient and healthcare-operator safety. Because COVID-19 is transmitted through droplets, and the viral load in pharyngeal secretions is high, maneuvers involving the upper airways, especially those inducing aerosolization such as swabbing procedures, yield a high risk of contamination of the environment and of the operator, which in turn represents a potential vehicle of infection for other patients.…”

“…4,5 To minimize the risk of cross-contamination between the operator and the patient, it is mandatory to wear appropriate PPE and to follow the standardized procedures of donning, doffing, and specimen handling, as indicated by most current guidelines. 3,4…”

Changes in the use of Otorhinolaryngology Emergency Department during the COVID-19 pandemic: report from Lombardy, Italy

“…After few days of confusion, Regional government disposed self-containment and lockdown of transportation, in order to contrast the outbreak. Meanwhile, Hospital dispositions dictated suspension of all elective and deferrable activities, regarding both surgery [2] and outpatient clinic visitations [3]. During this period of time and until the end of May, only Emergency Department consultations and postoperative and oncologic controls were guaranteed in our Department, according to dispositions provided and an internal reorganization based on the necessity for the Department to cope with the outbreak, while still providing adequate care for patients [4 -5 -6].…”